Determinants of stroke after coronary artery bypass grafting

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Abstract
Objectives: Cerebrovascular accidents (CVA) after CABG are deleterious complications whose prevention remains poorly defined. The aim of this study was to identify the determinants for CVA after CABG. Methods: Nine thousad nine hundred and sixteen patients underwent CABG at our institution from January 1992 to June 2002. Data were prospectively collected and univariate/multivariate analyses conducted. Results: Two hundred and eight patients (2.1%) suffered perioperative CVA. Univariate analysis showed a higher risk profile in the CVA group including advanced age, depressed percent left ventricular ejection fraction (LVEF), unstable angina, diabetes mellitus (DM), chronic renal failure (CRF), redo surgery, peripheral vascular disease (PVD), previous CVA, and higher Parsonnet score (PConclusions: Although occurrence of CVA seems mainly related to preoperative comorbidities, perioperative surgical variables, such as off-pump surgery, myocardial ischemia and cardiopulmonary bypass time, do not seem to independently influence CVA rate after CABG. In this regard CVA prevention should be performed before posing an indication to CABG, and closer evaluation of patients’ risk profiles and tailored clinical/surgical strategies for those patients at higher risk for CVA occurrence should be included.

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